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MONITORING WELL INSTALLATION REPOR-e <br /> Date: fid-`av CONSTRUCTION <br /> Premise Address: D z m n�GG, Total Depth 3 <br /> _ Screen Length (from) -(to) L <br /> Well No.: ffnFilter Pack (from) 4 (to) 30- <br /> Bentonite (from), G (to) g <br /> Inspector: �' ��/ S � Grout (from) 1n _(to) <br /> Drilling rig type,- Awl <br /> Permit No. Auger C.D. S?�— I.D. <br /> Drilling CompCompletion - Stove pipe/christie box (circle one) <br /> any/: �/�� �7 <br /> Driller: / 4 casing <br /> he, <br /> Consultant J k<� <br /> Geologist f w A3CVE GaCUND <br /> OO MPL.ETCN CSW ISTY�30X <br /> SPECIAL PERMIT INFO. CXcund Sul <br /> Distance to sever line quit <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> li. <br /> M <br /> C.. <br /> O <br /> SAMPLING :lor d <br /> Holding Temperature e�' _ <br /> YW pack <br /> Method — <br /> Screening Method = <br /> Tracking Sheet - ( y/ n ) A. <br /> SPOILS - <br /> Storage Method 5 r.�O l A,.5 7' MATERIALS , 0� <br /> Contamination Noted - (y/ n�j �U �r 4>f R °` <br /> Storage Location Casing type <br /> Bla.r-- <br /> Green ft. <br /> Slot size- Up <br /> GROUTING Bags cement <br /> Buckets bcntonite W �� <br /> Depth to water q Bags sand/graveI <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ((D/ n ) <br /> Quantity Installed Discussed with geologist: - (-(p/ n ) <br /> Type of method <br /> EH 29 29 <br />